Pelvic organ prolapse (POP) is the biggest secret in women’s health.

An estimated 50% of women around the world suffer in silence with vaginal tissues bulging externally, stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, overactive bladder, fecal incontinence, chronic constipation, and/or pain with intimacy, with no clue what is causing these frustrating symptoms. Isn’t it time the silo systems in women’s health came together to shine a beacon on the closeted aspects of women’s wellness (Figure 1)?

Figure 1. Stigma in women’s below-the-waist health. Image is courtesy of The Association for Pelvic Organ Prolapse Support.

My POP diagnosis was grade 3 cystocele, rectocele, and enterocele. Along my journey, I have experienced stress urinary incontinence, overactive bladder, and urinary hesitancy, as well as additional classic POP symptoms such as vaginal tissue bulge, chronic constipation, and one very rattling fecal incontinence episode at an airport. For a very short period, I experimented with a pessary, a medical device that provides internal support. The pessary fit well and worked great. However, adding one more thing to my hectic daily schedule was a deal-breaker. My urogynecologist never pushed surgery; I opted in to enable a speedy return to work. Surgery is not a one and done, however; the body continues to age. Lifestyle, behaviors, and comorbid conditions impact every woman navigating the pre or post POP journey, whether utilizing surgical or nonsurgical options. At 16 years post POP surgery, I continue to optimize postsurgical maintenance to maintain pelvic floor strength and integrity.

Nearly every woman diagnosed with pelvic organ prolapse begins her journey similar to how mine began, discovery upon diagnosis. No warning ahead of the curve during childbirth classes despite childbirth being the leading causal factor. No practitioner-to-patient conversation during routine pelvic examinations. No information shared when engaged in social conversation with other women. I was clueless that POP is a condition impacting women from their teens through the end of life. I was clueless what tissues bulging out of my vagina indicated. I was clueless why urine leakage occurred while coughing, laughing, sneezing, exercising, or engaging in intimacy.

The deeper I dug post diagnosis, the more frustrated I became. POP is not a relatively recently discovered condition. Nearly 4000 years of prolapse medical documentation dating back to the Kahun Gynaecologic Papyrus circa 1835 BCE confirms that little more than a whisper has been shared effectively, openly, proactively.

Upon confirmation that POP is the cryptic medical condition manifesting their awkward, embarrassing symptoms, women are anxious, frustrated, and often angry. The physical, emotional, social, sexual, fitness, and employment quality-of-life ramifications of POP can be devasting (Figure 2). Someone should have warned us ahead of the curve. What can and will the medical system do to address what is likely the most notable but least acknowledged shortfall in women’s health awareness, screening, practice, and policy?

Figure 2. Pelvic organ prolapse symptoms impact women’s quality of life and self-esteem. Image is courtesy of The Association for Pelvic Organ Prolapse Support.

The pandemic prevalence of POP certainly clarifies this condition is an aspect of female health that should be routinely screened for, diagnosed, and treated. The status quo is unacceptable. Given today’s proactive health mindset, it is inappropriate for a condition impacting 1 in 2 women to exist yet remain shrouded by stigma.

The steps to stimulate awareness of POP are taking too long. The current POP conversation at both public and diagnostic practitioner levels in multiple fields of women’s health practice is currently ineffective. Practitioner curriculum and focus are either insufficient or ineffective to lift the shroud of silence. If all fields of health care practitioners providing pelvic exams are not appropriately educated about the prevalence of POP and the need for routine screening, how is the status quo ever going to improve? We need to talk aloud about pelvic organ prolapse, publicly, comfortably. Educate women ahead of the curve, not after the fact. Silence should no more encase vaginal, pelvic, and intimate health than any other aspect of women’s wellness.

As in every underrecognized element of health, we don’t know what we don’t know. Every woman newly diagnosed with or suspecting she has POP because she has googled her symptoms online must travel down a diverse path of self-discovery. The list of POP variables goes on and on; 5 types, 4 grades of severity, numerous types of POP occurring simultaneously, diverse symptoms that may or may not occur. As occurred with breast cancer, erectile dysfunction, and sexually transmitted disease health awareness, POP will take its place in the history of stigmatized health medical evaluation and evolution.

Given diverse POP causals such as childbirth, menopause, heavy lifting, chronic constipation, chronic coughing, tissue integrity conditions such as Ehlers Danlos or Marfan, hard foot-strike fitness activities, and neuromuscular diseases such as multiple sclerosis, a logical forward shift in women’s health best practice would be inclusion of POP screening during women’s routine wellness pelvic examinations (Figure 3). And certainly women leaking urine should be assessed for pelvic organ prolapse.

Figure 3. Practitioner and patient opinions of pelvic organ prolapse treatment outcomes do not always align. Image is courtesy of The Association for Pelvic Organ Prolapse Support.

The most common question women experiencing POP ask is “Why wasn’t I informed of or screened for pelvic organ prolapse sooner?” It is imperative we talk openly and comfortably about all aspects of health, including what goes on down below. Women’s health should include talking out loud comfortably about vaginal, reproductive, defecatory, digestive, and reproductive health as a female culture. We have a long way to go.